snoezelen® used as therapeutic recreation for in-patient...

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Snoezelen® used as Therapeutic Recreation for In-Patient Geriatrics

Rebekah Plavnick

Florida International University


Abstract

The purpose of this article is to develop an evidence-based recreational therapy intervention

using Snoezelen® products within an in-patient geriatrics unit. This is achieved through

thorough pertinent literature review of scholarly journals. The protocol will be implemented,

documented and evaluated. Snoezelen® is a form of multi-sensory stimulation that is

experienced using visual, auditory, olfactory, and tactile stimuli (Baillon, 2004). The diagnoses

targeted by this intervention include chronic pain management and behavioral and psychological

symptoms of dementia (BPSD).


Table of Contents

Introduction………………………………………………………………………………………..4

Materials......………………………………………………………………………………………4

Assessments……………………………………………………………………………….4

Equipment……...………………………………………………………………………….5

Review of Literature……………………………....………………………………………………6

Protocol Considerations…..……………………………………………………………………...10

Protocol………………………………………………………………………………………..…12

Activity Analysis….……………………………………………………………………………..14

Protocol Evaluation………………………………………………………………………………18

References………………………………………………………………………………………..21


Introduction

Upon World War II’s end most first world countries has since become an ageing society leaving

14% of the population in the United States older than 65 years of age (The World Bank, 2016).

This is hypothesized to progressively rise until the year 2051. “One in 10 persons over 65, and

nearly half of those over 85, have probable Alzheimer’s disease. Further, at least half of nursing

home residents have dementia, Alzheimer’s disease or a related disorder” (Burns, 2000).

Snoezelen® was created over half a century ago in the 1960s to address people with learning

disabilities (Baillon, 2004). The Snoezelen® approach is one of multi-sensory stimulation

available by a designated room or mobile equipment. Snoezelen® activities provide participants

with a failure-free atmosphere ideal for patients struggling with instruction conceptualization.

“Recreational activities have been used as a way to introduce pleasurable experiences that

provide elderly residents with the opportunity to attain happiness and purpose and to improve

quality of life” (Minner, 2004). The benefits obtained from Snoezelen® therapy are listed as,

relaxation, behavior modification, improved cognitive function, improved quality of life, and

improved pain management (Chitsey, 2002).

Materials

ASSESSMENTS. Before implementing any therapeutic intervention an appropriate assessment

should be performed by the trained professional to determine the treatment parameters. Below

are three assessment tools available for sensory stimulation in adults with dementia.

The Sensory Assessment and Profiling Tool – “This assessment identifies the sensory

preference of a person. It is recommended that the Snoezelen® session should start

include equipment based on the person’s identified sensory preference. This will assist


with the transition into the Snoezelen® room and can be used as a starting point for

stimulating other senses as the therapy progresses” (Collier, 2014).

The Adult Sensory Profile – “This assessment identifies the level of stimulation a

person needs. The assessment identifies those are sensory seekers/low registration,

needing high levels of stimulation; or sensory avoiders/sensory sensitive, needing lower

levels of stimulation. With this information the level of stimulation required in the

Snoezelen® can be adjusted” (Collier, 2014).

The Pool Activity Level (PAL) Instrument for Occupational Profiling – “This

assessment gives guidance on how to run a Snoezelen® session given the severity of their

condition. This includes how to structure the activity. Guidance in how to facilitate the

Snoezelen® session, activity characteristics and guidance on how to start and end the

session” (Collier, 2014).

After conducting the PAL assessment the therapist should have the individual’s level of

functioning related to leisure involvement. The four levels of functioning from highest to lowest

are as follows: 1) Planned Activity Level, the individual can independently complete a task. 2)

Exploratory Level, the individual is less interested in task completion but more aroused by

familiar activities and effect of the process. 3) Sensory Level, the individual responds primarily

to the sensory components of the task. 4) Reflex Level, the individual is unaware of the

environment and movement is a reflex response to stimuli (Collier, 2008).

EQUIPMENT. Snoezelen® offers a variety of tools to incorporate in a multi-sensory room or

environment. Not all machines are suitable to be used in unison for an extended duration. The

individuals to participate in a Snoezelen® session should be assessed and machines should be

selected per need.


Review of Literature

Snoezelen® in long term care residents with dementia. BioMed Central released a study

protocol to determine whether three interventions, Snoezelen® being one of them, are effective

to reduce apathy in long-term care residents with dementia. The design of the trial is a cluster

randomized control trial with 20 nursing homes in Germany. The 20 nursing homes are

randomly allocated into 4 study groups. A baseline assessment is completed as well as after

interventions have begun one at 3, 6, and 12 months. “This trial will particularly contribute to the

evidence on efficacy of non-pharmacological interventions in dementia care” (Berg, 2010).

Each one of the four study groups (5 nursing homes) implemented a different

intervention, 1) structured reminiscence therapy, 2) 10 minute activation, 3) Snoezelen®, 4)

‘Sham Intervention’ (Berg, 2010). All interventions sessions operated on a one to one basis, once

or twice a week, lasting 10-20 minutes for 12 months. The ‘Sham Intervention’ was implemented

once a week for a duration of 20 minutes for 12 months. The ‘Sham Intervention’ utilizes

unstructured verbal conversation as the therapeutic modality.

The aim of the Snoezelen® group is “to improve the well-being of demented people by

positive stimulation of their senses with different materials in a multi-sensory stimulation room

or in the resident’s rom with a mobile Snoezelen® unit” (Berg, 2010). Outcomes are measured

by using the Apathy Evaluation Scale, Neuropsychiatric Inventory, Staff Observation Aggression

Scale-Revised, Smiley Face Rating Scale – SRS, Clinical Dementia Rating, and Care

Dependency Scale (Berg, 2010). Results will be published in a peer-reviewed med-line journal.

The effects of Snoezelen® on apathy, agitation, and ADLs in dementia patients on a short

term geriatric psychiatric inpatient unit. This study involved 24 patients with moderate to

severe dementia on a geriatric psychiatric unit. “All patients receive pharmacological therapy,


occupational therapy, structured hospital environment, and were randomized to receive multi-

sensory behavior therapy or a structured activity session” (Staal, 2007). Elderly patients do not

tolerate pharmacological therapies as well as younger patients and arise the need for additional

supportive therapies such as sensory stimulation. Staal formed an assessment method that

individualizes the intervention (2010). Baseline and post-trial measures of agitation, apathy, and

ADLS were recorded.

The hypothesis fueling this trial is, “participants randomized to combined psychiatric care

and multi-sensory behavior therapy would have a greater reduction in agitation and apathy and

improvement in ADLs compared to those who received standard psychiatric care and attention

controlled structured activity group” (Staal, 2010). Outcomes were measured using the following

tools, The Global Deterioration Scale, The Pittsburgh Agitation Scale, The Scale for the

Assessment of Negative Symptoms in Alzheimer’s disease, The Katz Index of Activities of Daily

Living, Redefined Activities of Daily Living Scale, and The Mini Mental Status Exam.

The results of this trial reveal that the group attended multi-sensory stimulation

interventions improved significantly in levels of agitation as compared to the control group. The

multi-sensory group significantly improved in levels of apathy as compared to the control. There

is no significant difference in ADL baseline between the two groups (Staal, 2010).

Snoezelen activity: the good shepherd nursing home experience. A nursing home in Missouri

implemented Snoezelen® therapy and reported, “…the use of Snoezelen® therapy has been a

successful and rewarding experience for both residents and staff members” (Minner, 2004). The

nursing home chose to use a single facilitator model. One individual, a CNA or CMT, was

responsible for scheduling, room up-keep, charting, and helping residents.


The registered nurse coordinator is responsible for choosing participants for Snoezelen®

therapy. Residents who exhibited episodes of adverse behaviors were given priority (Minner,

2004). 19 residents used the Snoezelen® room in a one year time. Snoezelen® Therapy is

implemented when residents begin to have behavior escalations, this normally occurs at time of

shift changes (Minner, 2004).

Tools to analyze outcomes was The Comfort/Discomfort Scale (CDS). 324 visits were

made to the Snoezelen® therapy room in the year time. The facilitator administered the CDS

before, during and one hour after the intervention. Positive behaviors were recorded to show an

increase from 3.7 to 5.3 following the intervention. Negative behaviors decreased from 2.1 to 0.9

following the intervention. This a significant change and proves the value of Snoezelen® therapy

(Minner, 2004).

Snoezelen, a multisensory environmental intervention. “The purpose of this article is to

review the published literature pertaining to the use of multisensory stimulation with older adults

and to provide recommendations for future practice and research” (Chitsey, 2002). One study

that is outlined in Chitsey’s comprehensive review is the first experimental controlled study

investigating multi-sensory therapy for demented adults by Loew and Silverstone. This study

involved 14 males who participated in sessions of multi-sensory activities and 14 similar males

continued participation in routine activities. This study lasted for six months. “The results of the

study indicated no significant change in the cognitive function of the experimental or control

group, but results did suggest that the experitmental group improved their memory, attention,

ability to retain information, and orientation to time” (Chitsey, 2002).

A second study discussed in this comprehensive review is one by Paire and Karney that

observes multi-sensory sessions on older adults with psychiatric disorders. “The experimental


group showed improved hygiene skills, demonstrated an increased interest in activities, and were

more involved in group participation” (Chitsey, 2002). Maloney and Daily published a 3 year

longitudinal observational study similar to Paire and Karney. “Maloney and Daily found that

stimulation therapy helped older adults with dementia to relax and achieve a more peaceful state,

while becoming more sociable and talkative” (Chitsey, 2002).

A study conducted by Baker et al. compared the effects of eight Snoezelen sessions to a

control group who participated in eight traditional activity sessions. “Results indicated that the

control group’s deviant behaviors and social and speech skills worsened…experimental group

remained the same on those measures” (Chitsey, 2002). Both groups had an increase in

enjoyment, contentment, happiness, attentiveness, and verbal communication. Chitsey’s

comprehensive review of literature around multi-sensory stimulation as therapy concludes by

stating, “although empirical research investigating multi-sensory stimulation in older adults is

minimal, currently 90% of empirical research supports its use as both therapeutic and effective”

(2002).

Comparison of Snoezelen to reminiscence therapy on behavior of patients with dementia.

This study involved 20 patients with dementia and significant agitated behaviors. Participant’s

behavior, mood and heart rate were measured before during and after sessions. Each patient

underwent three sessions of reminiscence therapy and Snoezelen® therapy (Baillon, 2004). The

result of this study concludes that there is no significant difference in the benefit of Snoezelen®

therapy and reminiscence therapy. All sessions were implemented on a one to one basis for 40

minutes unless the patient chose to leave group (Baillon, 2004).

Snoezelen® for relaxation within chronic pain management. This study by Pat Schofield was

initiated to explore the effectiveness of teaching relaxation techniques in a multi-sensory


environment or a pain clinic (2002). The study involved a control group of a mean age of 48

years with duration of 6 years of pain and an experimental group of a mean age of 48.2 and

duration of 7.5 years of pain. The variables were measured at 1 month, 3 months and post-

intervention. These variables include coping, self-efficacy, anxiety, depression, pain, and

disability (Schofield, 2002).

The results are as follows: The experimental group experienced significant reductions in

pain and an improvement in self-efficacy and sickness impact for the following scales: physical,

psychosocial, recreation and sleep. “The findings suggest that Snoezelen® environments are

effective as, if not slightly better than, teaching relaxation within the traditional pain clinic

environment for this group of patients” (Schofield, 2002).

Protocol Considerations

When forming a program protocol it is important to begin with evidence-based research, specific

program plan and an activity analysis. An activity analysis is described as, “a process that

involves the systematic application of selected sets of constructs and variables to break down and

examine a given authority to determine the behavioral requirements inherent for successful

participation and that may contribute to the achievement of client outcomes” (Stumbo, 2004). An

activity analysis involves: interaction and social requirements, cognitive requirements, emotional

(affective) factors, and administrative aspects. Variables outlined on an activity analysis are age,

number of clients, facilities available, equipment and supplies, staff skills, carryover skills, and

activity modification (Stumbo, 2004).

Upon completion of an activity analysis it is appropriate to make individual program

protocols. Program protocols are “documents that describe the ‘best practice’ of a specific

intervention as applied to a specific group of client needs that have been standardized and result


from recent research evidence, literature reviews, or professional consensus” (Stumbo, 2004).

Therapeutic recreation intervention protocols include: program title, general statement of

purpose, description of program, client goals/objections, referral criteria, contraindicated criteria,

intervention techniques, certification criteria, risk management considerations, outcomes

expected, and program evaluation (Stumbo, 2004).

Collier who is a noted researcher on the effects of multi-sensory interventions stated,

“Multi-sensory environment activity most commonly fails when little or no consideration is

given to an individual’s abilities or of how the session should be facilitated” (2008). She

described the guidelines for multi-sensory activity to be 1) simple, short tasks presented one-step

at a time with a limited chance for failure 2) receptive, routine and familiar 3) multi-sensory,

sight, sound, taste, tactile, smell, movement 4) safe, with little environmental risk 5) adaptable,

spontaneous vs. planned, individual vs. group 6) respectful, offering compatibility with age,

using reminiscing skills, and incorporating old interest (Collier, 2008).

Utilizing relevant and recent research, professional considerations, facility

considerations, and standardized diagnostic outcomes, goals and objectives three Snoezelen®

intervention protocols have been formed for the use in the Veterans Affair Hospital, West Haven,

Connecticut for the recreation therapy professional. These intervention protocols will include an

activity analysis and evaluation. These intervention protocols are adaptable for use in various

settings when utilizing the pertinent research available in the literature review and protocol

considerations portion of this paper. Certain areas of protocol should not be adapted including,

certification criteria, referral criteria, client goals and objectives, and outcomes expected.


Multi-Sensory Stimulation Protocol

Program Protocol Rebekah Plavnick

Program: multi-sensory stimulation

Participants: 1

Population: in-patient geriatric with a major neuro-cognitive impairment [Alzheimer’s Disease, Vascular Dementia, Parkinson’s Disease, Lewy Body Disease, Fronto-

Temporal Dementia] Facility: multi-sensory environment (MSE) room/area

Facilitator: 1

Equipment: multi-sensory devices (touch, taste, smell, audio, visual, movement)

I. Treatment Modality

Multi-sensory stimulation therapy for dementia and end-of-life care

II. Rationale

Multi-sensory therapy interventions can be implemented in various ways. People who are

institutionalized often experience sensory deprivation. Multi-sensory stimulation includes

arousing all senses (touch, taste, hearing, vision, movement). The optimal environment for multi-

sensory therapy for people who have dementia is on a one-to-one, failure-free basis (Minner,

2004).

“Although empirical research investigating multi-sensory stimulation in older adults is minimal,

currently 90% of empirical research supports its use as both therapeutic and effective” (Chitsey,

2002). “Maloney and Daily found that stimulation therapy helped older adults with dementia to

relax and achieve a more peaceful state, while becoming more sociable and talkative” (Chitsey,

2002). Baillon et al found that sessions of 40 minutes are appropriate for adults with dementia, if

the participant wishes to leave at any time during the session they should not be stopped (2004).

Berg’s study protocol suggest a one to one basis for 10-20 minutes (2010). Baillon and Minner’s

research both concur that multi-sensory stimulation should be implemented on a one to one basis

(2004, 2004).

III. Referrals

Participants will be referred to this program by physicians or recreation therapy professionals

based off of assessment. Participants must have a diagnosis of a neuro-cognitive impairment

meeting the criteria outlined in the DSM V. Participants should be institutionalized, experiencing

sensory deprivation, isolative tendencies, and/or behavior issues.

IV. Risk Management

Participants who are not appropriate for this program include: people with medical precautions

that inhibit their ability to leave their room such as, MRSA, and participants who are not

conscious and unarousable. Other participants might require special considerations for approval

and admittance to program.


V. Criteria

Structure Criteria Process Criteria Outcome Criteria

Multi-sensory stimulation

therapy will be implemented

on a one-to-one basis. Each

session will last 30 minutes

but can end before or last

longer. This intervention will

be available 5 times a week.

Therapist will:

Participant will:

Depending on tolerance

Patient will be introduced to

the equipment one sense at a

time

Therapist will provide

materials and equipment as

tolerated

Patient will interact with the

materials and equipment as

tolerated and desired

All senses will be engaged for

complete sensory emersion

Therapist will assure a safe

environment that engages all

senses

Patient will be comfortable

and engaging with materials

and equipment as desired and

tolerated

Session will naturally end or

depending on facility

requirements end at a set time

Therapist will slowly

transition senses. One sensory

stimulating device or material

will be terminated at a time.

Patient shows signs of

disinterest/lack of

comfort/over-stimulating the

session should be ended.

Patient will be aware of

session slowly ending.

VI. Conclusion

The therapist implementing multi-sensory stimulation should be a supervisor and PRN

facilitator. The participant is in control of the stimulation of his senses. Various materials and

equipment (lights, aromas, food, etc) are integrated as tolerated. All sessions should be

documented. Effectiveness and therapist performance should be assessed for success routinely.


Activity:_Multi-Sensory Stimulation ______________________________________

PHYSICAL ASPECTS:

1. What is the primary body position required?

x_lying down x_sitting __other:_______________

x_kneeling x_standing

2. What body parts are required?

x_arms x_feet x_upper torso

x_hands x_neck x_lower torso

x_legs x_head __other:_______________

3. What types of movement does the activity require?

__punching __bending x_reaching

x_stretching __catching x_grasping

x_standing __throwing __skipping/hopping

x_walking __hitting __running

__other:_____________________________________________________

4. What are the primary senses required for the activity?

x_touch x_sight x_smell

x_taste x_ hearing x_movement

5. What is the amount of coordination and movement between body parts required by the

activity?

Much 1 2 3 4 5 Little

6. What is the amount of hand-eye coordination needed for the activity?


7. What is the degree of strength needed for the activity?


8. What is the degree of speed needed for the activity?


9. What is the degree of endurance needed for the activity?


10. What is the degree of energy needed for activity?


11. What is the degree of flexibility needed for the activity?


SOCIAL ASPECTS:

1. What is the primary social interaction pattern required in the activity?

x__Intraindividual (action taking place within the mind or action involving the mind and

a part of the body; requires no contact with another person or external object)

x__Extraindividual (action directed by a person toward an object; requires no contact

with another person)

___Aggregate (action directed by a person toward an object while in the company of

other persons who also are directing actions toward objects; action is not directed toward

each other; no interaction required among participants)


___Interindividual (action of a competitive nature directed by one person toward another)

___Unilateral (action of a competitive nature among three or more persons, one of whom

is an antagonist; interaction is in simultaneous competitive relationship)

___Multilateral (action of a competitive nature among three or more persons with no one

person as an antagonist)

___Intragroup (action of a cooperative nature by two or more persons intent upon

reaching a mutual goal; action requires positive verbal or nonverbal interaction)

___Intergroup (action of a competitive nature between two or more intragroups)

2. What is the minimum number or maximum number of people required for this activity?

_1_minimum _1_maximum

3. What clothing is needed to be social appropriate?

4. How much physical proximity is required by this activity?

Close 1 2 3 4 5 Distant

5. How much physical contact is required by this activity?


6. What degree of communication is required by the activity?

High 1 2 3 4 5 Low

7. What degree of noise is generated by the activity?


COGNITIVE ASPECTS

1. How many rules are required in the activity?

Many 1 2 3 4 5 Few

2. How complex are the rules to understand?

Complex 1 2 3 4 5 Simple

3. What degree of strategy is required in the activity?

Many 1 2 3 4 5 Little

4. What degree of complexity is involved in scoring?


5. What degree of long-term memory is required in the activity?


6. What degree of short-term memory or immediate recall is required in the activity?


7. What degree of verbalization of thought process is required in the activity?


8. What degree of concentration is required in the activity?


9. What degree of concrete thinking is required by the activity?


10. What degree of abstract thinking is required by the activity?



11. To what degree are each of the following skills used in the activity?

Reading Much 1 2 3 4 5 Little

Writing Much 1 2 3 4 5 Little

Math Much 1 2 3 4 5 Little

Spelling Much 1 2 3 4 5 Little

12. To what degree does the participant need to identify or use the following?

Form & Shape Much 1 2 3 4 5 Little

Colors Much 1 2 3 4 5 Little

Size Much 1 2 3 4 5 Little

Numbers Much 1 2 3 4 5 Little

Body Parts Much 1 2 3 4 5 Little

Directionality Much 1 2 3 4 5 Little

AFFECTIVE ASPECTS

1. To what degree does the participant have the opportunity or outlet to express the

following?

Joy Much 1 2 3 4 5 Little

Guilt Much 1 2 3 4 5 Little

Pain Much 1 2 3 4 5 Little

Anger Much 1 2 3 4 5 Little

Fear Much 1 2 3 4 5 Little

Frustration Much 1 2 3 4 5 Little

2. To what degree does the participant need to inhibit or control the expression of the

following?

Joy Much 1 2 3 4 5 Little

Guilt Much 1 2 3 4 5 Little

Pain Much 1 2 3 4 5 Little

Anger Much 1 2 3 4 5 Little

Fear Much 1 2 3 4 5 Little

Frustration Much 1 2 3 4 5 Little

ADMINISTRATIVE ASPECTS

1. What type of leadership style is required by the activity/

__specific activity-skill expertise x_supervisory

x_general activity-skill expertise __no specific leadership style needed

2. What type of equipment is needed for this activity?

x_specific commercial product (specify:_sensory stimulation (i.e. Snoezelen)

x_can be made (specify:__food________)

__no equipment required

3. What type of facility is required by the activity?

__specific natural environment (specify:__________)

x_specific created environment (specify:_MSE_____)


__no specific environment required

4. What is the duration of the activity?

x_set time (specify:__________)

x_natural end

x_continuous

5. What is the number of participants required for the activity?

__any number can participate

x_fixed number or multiple (specify:__1__)

Printed Name: _Rebekah J Plavnick___________

Signature: ____________________________

Date: _April 15, 2016_______________


Protocol Evaluation

Multi-Sensory Stimulation was implemented by this writer, Rebekah Plavnick a senior

recreational therapy intern. The program was implemented at the Veteran’s Affair hospital in

West Haven, Connecticut. The participant at the time was an in-patient geriatric. His primary

medical provider was spoken to about limitations and appropriateness. Without assessment the

patient is believed to be at an exploratory functioning level. He is appropriate for multi-sensory

stimulation because of a diagnosis of vascular dementia and being admitted for an extended

hospitalization.

The Snoezelen® equipment was set up in an empty hospital room because of its dark

environment. The equipment used in the room included: mobile bubble machine, two projectors,

fibro-optic strands, two tactile balls, nature sounds CD.

The participant was approached by me. I described the MSE to the patient as a room that

promotes relaxation and self-exploring. He was receptive to the information and expressed that

he understood. I asked if he would like to go into the room. He agreed to go in and was assisted

to room. He transferred from a manual wheelchair to a large recliner that contained the two

tactile balls and a soft blanket that he brought himself. He was asked about his comfort level to

assure successful transition. He responded well to all equipment being on. Veteran independently

observed the fiber-optic strands while seated. Veteran independently observed all equipment. He

only physically engaged with the fiber-optic strands. Veteran brought a magazine with him into

the room and he read and observed it. This session lasted for 20 minutes. He reported that he was

indifferent about the room and that he would come back again if available.

Considerations for future implementation include: change locations due to unmovable hospital

equipment in room and noise in the hallway. Incorporate a taste stimuli when implementing


multi-sensory stimulation. Implement during shift change as suggested by Minner’s research

(2004). Purchase appropriate assessments to form better individual treatment plans.

There was no adverse effects recorded by this writer or participant, however the absence of

negative outcomes does not equate to a positive outcome. Further intervention should be

implemented and recorded for multi-sensory stimulation analysis on in-patients with a neuro-

cognitive impairment.


References

Baillon, S., Diepen, E. V., Prettyman, R., Redman, J., Rooke, N., & Campbell, R. (2004). A

comparison of the effects of Snoezelen and reminiscence therapy on the agitated

behaviour of patients with dementia. International Journal of Geriatric

Psychiatry, 19(11), 1047-1052. Retrieved from www.interscience.wiley.com.

Berg, A., Sadowski, K., Beyrodt, M., Hanns, S., Zimmermann, M., Langer, G., . . . Behrens, J.

(2010). Snoezelen, structured reminiscence therapy and 10-minutes activation in long

term care residents with dementia (WISDE): Study protocol of a cluster randomized

controlled trial. BMC Geriatrics, 10(1), 5.

Burns, I., Cox, H., & Plant, H. (2000). Leisure or therapeutics? Snoezelen and the care of older

persons with dementia. International Journal of Nursing Practice Int J Nurs Pract, 6(3),

118-126.

Chitsey, A. M., Haight, B. K., & Jones, M. M. (2002). Snoezelen®: A Multisensory

Environmental Intervention. Journal of Gerontological Nursing J Gerontol Nurs, 28(3),

41-49.

Collier, L. (2014). Dementia and Snoezelen. Retrieved from https://www.rompa.com/media/free-

resources/Dementia_and_Snoezelen.pdf

Collier, L., & Truman, J. (2008). Exploring the Multi-Sensory Environment as a Leisure

Resource for People with Complex Neurological Disabilities. NeuroRehabilitation, 23,

361-367.

Minner, D., Hoffstetter, P., Casey, L., & Jones, D. (2004). Snoezelen Activity: The Good

Shepherd Nursing Home Experience. Journal of Nursing Care Quality, 19(4), 343-348.

http://www.interscience.wiley.com/

https://www.rompa.com/media/free-resources/Dementia_and_Snoezelen.pdf

https://www.rompa.com/media/free-resources/Dementia_and_Snoezelen.pdf


Schofield, P. (2002). Evaluating Snoezelen for relaxation within chronic pain management.

British Journal of Nursing Br J Nursing, 11(12), 812-821.

Staal, J. A., Sacks, A., Matheis, R., Collier, L., Calia, T., Hanif, H., & Kofman, E. S. (2007). The

Effects of Snoezelen (Multi-Sensory Behavior Therapy) and Psychiatric Care on

Agitation, Apathy, and Activities of Daily Living in Dementia Patients on a Short Term

Geriatric Psychiatric Inpatient Unit. The International Journal of Psychiatry in Medicine,

37(4), 357-370.

Stumbo, N. J., & Peterson, C. A. (2004). Therapeutic Recreation Program Design: Principles &

Procedures (4th ed.). San Franciso, CA: Benjamin Cummings.

The World Bank. Population ages 65 and above (% of total). (2016). Retrieved March 10, 2016,

from http://data.worldbank.org/indicator/SP.POP.65UP.TO.ZS

http://data.worldbank.org/indicator/SP.POP.65UP.TO.ZS

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